Dynamic and omni wedge implementation on an Elekta SL linac

The concommitant use of a multileaf collimator (MLC) and a wedge can result in conflicts in the optimal collimator angle if both MLC and wedge are fixed relative to one another. This is particularly true of linacs in which a single wedge orientation is provided. In this paper, a solution is provided that makes use of two orthogonal universal wedges (omni wedge). Although this technique can be applied regardless of the means by which the wedged fields are implemented, the measurements reported in this paper were performed using a fixed, internal mechanical wedge coupled with a dynamic wedge, formed by the motion of one of the backup jaws. An implementation of a dynamic wedge for the Elekta SL series of linear accelerators is presented. Results of measurements of the dosimetric characteristics of both the particular implementation of the dynamic wedge and of the omni field are presented. For the dynamic wedge, measurements were made of the wedge factor and dose profile as a function of field size and depth. In addition, the effects of variables, such as dynamic delivery technique and direction of diaphragm motion, on the dynamic wedge profiles were studied and discussed. For the omni wedge, measurements were made of the degree to which the mathematical formalism for describing an omni wedge matches the measured isodose distributions. Comparisons between mechanical wedge dose distributions and the omni wedge were also made.